图 1 小儿上尿路扩张疾病诊断评价流程图 注:VCUG:排泄性膀胱尿道造影。
表1 EAU 指南中 UPJ 和 UVJ 梗阻的证据和级别
表2 EAU 指南中 UPJ 和 UVJ 梗阻的指南推荐及等级
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[1]周辉霞,贾红帅,张巍,李品.2022版欧洲泌尿外科学会小儿泌尿诊疗指南更新解读——UPJ与UVJ梗阻、后尿道瓣膜专题[J].泌尿外科杂志(电子版),2022,14(02):1-5+9.DOI:10.20020/j.CNKI.1674-7410.2022.02.01.
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后尿道瓣膜是新生儿期发现的少数危及生命的先天性尿路异常之一,近三分之一的病例出现肾功能不全。双侧输尿管肾积水和膀胱增大是新生儿 PUV 的可疑征象。VCUG 是 PUV 的诊断的金标准。肾动态显像可用于肾功能的评估。发现获益人群是产前治疗的关键。
产后治疗包括膀胱引流、经尿道或耻骨上引流,如果患儿病情允许,需在内镜下切开瓣膜。如果膀胱引流不足以引流上尿路尿液,应考虑行肾造瘘引流。
因为合并膀胱功能障碍,必须对 PUV 患者施行终身随访。10%~47%的患者可能发展为终末期肾功能衰竭,这些患者可进行肾移植。
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